Co esponding au ho : Soul ana Rabie.
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Ob u a o He nia, an unusual cause o small bowel obs uc ion: Radiog aphic and
su gical indings
Soul ana Rabie *, Azzi Abdenbi, Benaghmouch Fadi, Laiz ach a , Aggou i Younes and Ai Laalim Said
Depa men o Gene al Su ge y and Diges i e Oncology, Uni e si y Hospi al Mohamed VI o Tangie , Mo occo.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 3833-3836
Publica ion his o y: Recei ed on 05 Ma ch 2025; e ised on 22 Ap il 2025; accep ed on 24 Ap il 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.1.1278
Abs ac
Ob u a o he nia is a a e condi ion, i con ibu es o abou 1% o incidence o all he nias, e en less equen ly a e hey
diagnosed p eope a i ely, wi h he as majo i y being ound inciden ally a lapa o omy o small bowel obs uc ion.
Diagnosing an ob u a o he nia clinically is a challenging one due o ague signs and symp oms. Pel ic CT is almos
100% accu a e in he diagnosis o ob u a o he nia and should be he modali y o choice in olde pa ien s p esen ing
wi h in es inal obs uc ion o unknown e iology. This case epo desc ibes a hin elde ly woman, wi h a his o y o 5
days acu e abdominal pain, which was co ec ly diagnosed be o e su ge y as an inca ce a ed ob u a o he nia using CT.
Keywo ds: Ob u a o he nia; S angula ion; In es inal obs uc ion; Compu ed omog aphy
1. In oduc ion
An ob u a o he nia is a a e cause o all abdominal wall he nias commonly seen in emales, hey i s desc ibed in 1724
by A naud de Ronsil. Ob u a o he nia is a e; hey ep esen only 0.05– 1.4% o all abdominal-wall he nias. Ob u a o
he nias a e commonly ound in elde ly, emacia ed, mul ipa ous women wi h concu en medical condi ions. Possible
con ibu ing ac o s include he deg ada ion o he a body wi hin he ob u a o canal.
Due o i s a i y and unspeci ic ea ly symp oms, ob u a o he nia can s ill be misleading e en o he mos expe ienced
su geons. Delays in ope a i e in e en ion can con ibu e o he inc eased need o esec ion o gang enous bowel seen
in up o 50% o ob u a o he nia epai s; pe iope a i e mo ali y a es in such se ings can be as high as 70%.
The use ulness o compu ed omog aphy (CT) in he diagnosis o OH was epo ed by Cubillo in 1983; since hen, i has
been assis ing su geons in he eme gency managemen o his diso de . Wi h he imp o emen o equipmen , a
compu ed omog aphy (CT) scan is able o de ec he ob u a o he nia p eope a i ely, being consis en wi h he indings
o lapa o omy o ob u a o he nia. Ea ly CT imaging allows ea ly diagnosis and educes mo bidi y and mo ali y
associa ed wi h ob u a o he nia.
Gi en ob u a o he nia is a e, hei managemen has been based on indi idual case epo s o case se ies ha ha e
esul ed in a ew sugges ed diagnos ic and he apeu ic algo i hms. The ollowing case epo highligh s hese diagnos ic
di icul ies and e iews he cu en li e a u e on diagnosis and managemen o such cases.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 3833-3836
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2. Case epo
A 73-yea -old ail woman (BMI = 16,44 kg/m²) who ga e bi h o 6 kids and denied any his o y o p e ious abdominal
su ge y, was sen o ou eme gency depa men because o acu e abdominal pain, absolu e cons ipa ion and omi ing
o 5 days.
She i wen o nea by hospi al whe e an X- ay o he abdomen showed e idence o small gu obs uc ion wi h no
pe o a ion. hen she was e e ed o ou eme gency su gical depa men hospi al o be e e alua ion and
managemen .
On admission, she epo s ecen weigh loss du ing his yea , and in e mi en abdominal pain h oughou he pas
mon h. On examina ion, he hea a e was 88 bea s/min and blood p essu e we e 130/80 mm Hg. He abdomen was
so and non-dis ended, and no g oin he nias. Rec al examina ion is un ema kable. The Howship-Rombe g sign is no
p esen . Biochemical es ing showed e idence o acu e kidney inju y.
An u gen CT scan e ealed an inca ce a ed igh ob u a o he nia con aining small bowel loop.
Figu e 1 Co onal CT sec ion showing a igh ob u a o he nia wi h an inca ce a ed in es inal loop
Figu e 2 Axial CT sec ion showing a igh ob u a o he nia wi h an inca ce a ed in es inal loop
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 3833-3836
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A lapa o omy, we con i m ha a small bowel segmen was he nia ed in igh ob u a o o amen, abou 1,7 m p oximal
o ileocecal al e, he bowel p oximal o he he nia was dila ed, while he dis al segmen was collapsed. The inca ce a ed
in es ine was educed and a pe o a ed lesion was no ed. he bowel de ec was closed wi h su u es. The o i ice o he
ob u a o canal was closed wi h in e posi ion o ound ligamen and bladde .
Figu e 3 Pe ope a i e image o ob u a o he nia wi h inca ce a ed in es inal loop
The pa ien was eco e ed une en ully and discha ged six days a e ope a ion.
3. Discussion
Due o hei low incidence and non-speci ic symp oms, ob u a o he nias may p esen a diagnos ic challenge o he
adiologis o su geon. Ob u a o he nias a e exceedingly a e, cons i u ing 0.073% o all he nias in he Wes and 1%
in he Fa Eas ; e en less equen ly a e hey diagnosed p eope a i ely, wi h he as majo i y being ound inciden ally
a lapa o omy o SB obs uc ion [1].
The high mo bidi y (30%) and mo ali y (10%) a es associa ed wi h ob u a o he nia, which is mos likely ela ed o
disease acui y (63% p esen ed eme gen ly), g ea e need o bowel esec ion (47%), and unde lying medical
como bidi ies in a ail, elde ly pa ien , s ess he impo ance o a p omp diagnosis and immedia e ope a i e
in e en ion.[5]
The majo i y o ob u a o he nia pa ien s p esen as he classic desc ip ion o a “skinny old lady,” wi h signs and
symp oms sugges i e o bowel obs uc ion. Mul iple p edisposing ac o s ha e been associa ed wi h ob u a o he nia
o ma ion, including a wide pel is causing a iangula shaped ob u a o canal wi h an inc eased ans e se diame e ,
mul ipa i y, inc eased age usually in conjunc ion wi h emacia ion, as well as ch onic concomi an medical condi ions
which inc ease he in aabdominal p essu e, such as ch onic obs uc i e pulmona y disease, ch onic cons ipa ion,
asci es, and kyphoscoliosis.[3]
They occu when he in es ine p o udes h ough a de ec in he ob u a o o amen and in o he ob u a o canal, gi ing
ise o a combined clinical pic u e o bowel obs uc ion. Diagnosis o an ob u a o he nia be o e su ge y is di icul due
o i s non-speci ic symp oms and because he e is usually in es inal obs uc ion. Clinical diagnosis based on he
HowshipRombe g sign p esen ed pain sp eading along he medial high o he knee because o a ne ous blockage by
he he nia mass and pain inc easing when he leg was sp ead ou and o a ed ou side in 13%-68% o cases [ 6].
CT is he ‘gold s anda d’ o he diagnosis o ob u a o he nia, and has a high a e o accu acy; Since he ea ly diagnosis
o ob u a o he nia helps o dec ease bo h in es inal esec ion a e and su gical mo ali y, a CT scan is ecommended
o pa ien s wi h small bowel obs uc ion o unde e mined cause, especially o hose wi h isk ac o s o ob u a o
he nia. Ou case epo hus highligh s he alue o a CT scan in es ablishing a p omp p eope a i e diagnosis o an
ob u a o he nia, app op ia e planning o su gical in e en ion, and hus op imising he ou come [7].
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 3833-3836
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Ob u a o he nia epai is usually accomplished by midline lapa o omy and p ima y epai . Howe e , wi h he ad en
o lapa oscopy, addi ional choices o mesh, and he possibili y o a p eope a i e diagnosis, o he op ions o epai now
exis . The ex ape i oneal app oach using an inguinal o high incision is a possibili y; howe e , a p eope a i e diagnosis
is necessa y. Fu he mo e, in he e en o s angula ed bowel, esec ion h ough his incision would p o e di icul .
Mesh-based epai s may p o e bene icial in ce ain ci cums ances in which p ima y issue epai s a e challenging, such
is o en he case when he bounda ies o he he nia a e igid and di icul o app oxima e. A mul i ude o ma e ials ha e
been used in he pas o s abilize he closu e such as cos al ca ilage, inne mos ibe s o pec ineus muscle, olled-up
an alum gauze, os eope ios eal lap om he pubic bone, ee omen um, and u e ine undus o ound ligamen . ou
pa ien , he diges i e leak p e en ed us om using p os he ic ma e ial, and a simple closu e was impossible because o
he igidi y o he ana omical s uc u es, we chose a epai wi h in e posi ion o he ound ligamen and he bladde ,
which was easy o pe o m [2,4].
4. Conclusion
Ob u a o he nia is a a e bu signi ican cause o in es inal obs uc ion and a diagnos ic challenge o su geon and
adiologis . The diagnosis o ob u a o he nia can be made by CT scan p eope a i ely. Despi e ha ing delayed
p esen a ion, ou pa ien has good pos ope a i e ou come.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
S a emen o in o med consen
In o med consen was ob ained om all indi idual pa icipan s included in he s udy.
Re e ences
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[3] B yan T.L., Ums o R.K., J . Lapa oscopic epai o an inca ce a ed ob u a o he nia. Su gical Endoscopy.
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